Effect of Information and Telephone-Guided Access to Community Support for People with Chronic Kidney Disease: Randomised Controlled Trial

Background: Implementation of self-management support in traditional primary care settings has proved difficult, encouraging the development of alternative models which actively link to community resources. Chronic kidney disease (CKD) is a common condition usually diagnosed in the presence of other co-morbidities. This trial aimed to determine the effectiveness of an intervention to provide information and telephone-guided access to community support versus usual care for patients with stage 3 CKD. Methods and Findings: In a pragmatic, two-arm, patient level randomised controlled trial 436 patients with a diagnosis of stage 3 CKD were recruited from 24 general practices in Greater Manchester. Patients were randomised to intervention (215) or usual care (221). Primary outcome measures were health related quality of life (EQ-5D health questionnaire), blood pressure control, and positive and active engagement in life (heiQ) at 6 months. At 6 months, mean health related quality of life was significantly higher for the intervention group (adjusted mean difference = 0.05; 95% CI = 0.01, 0.08) and blood pressure was controlled for a significantly greater proportion of patients in the intervention group (adjusted odds ratio = 1.85; 95% CI = 1.25, 2.72). Patients did not differ significantly in positive and active engagement in life. The intervention group reported a reduction in costs compared with control. Conclusions: An intervention to provide tailored information and telephone-guided access to community resources was associated with modest but significant improvements in health related quality of life and better maintenance of blood pressure control for patients with stage 3 CKD compared with usual care. However, further research is required to identify the mechanisms of action of the intervention

Predictors of patient self-report of chronic kidney disease: baseline analysis of a randomised controlled trial

Background: Improving the quality of care for patients with vascular disease is a priority. Clinical guidance has emphasised the importance of early identification and active management of chronic kidney disease (CKD) in primary care in order to maintain vascular health. However, awareness of stage 3 CKD amongst patients remains limited. We aimed to identify predictors of patient self-report of CKD to inform tailoring of conversations around CKD in primary care for diverse patient populations. Methods: We conducted a cross-sectional analysis of baseline data from 436 patients with stage 3 CKD from 24 GP practices taking part in a randomised controlled trial (RCT) evaluating a complex self-management intervention, which aimed to support the maintenance of vascular health in patients with stage 3 CKD. Potential predictors of patient self-report of CKD included demographics, stage of CKD, cardiovascular risk, self-reported co-morbidities, health status, self-management ability, and health service utilisation. Results: Around half (52%, n = 227) of patients did not self-report CKD. Self-report rates did not appreciably differ by practice. Multivariate analysis revealed that female patients (p = 0.004), and patients with stage 3b CKD (p < 0.001), and with higher anxiety levels (p < 0.001), were more likely to self-report CKD. Conclusions: Self-report of kidney problems by patients on CKD registers was variable and patterned by sociodemographic factors. Although it cannot be assumed that failure to self-report indicates a lack of awareness of CKD, our data do suggest the need for greater consistency in discussions around kidney health, with meaningful and relevant clinical dialogue that is aligned with existing clinical encounters to enable shared decision making and minimise anxiety

Detection of biotic and abiotic stresses in crops by using hierarchical self organizing classifiers

Hyperspectral signatures can provide abundant information regarding health status of crops; however it is difficult to discriminate between biotic and abiotic stress. In this study, the case of simultaneous occurrence of yellow rust disease symptoms and nitrogen stress was investigated by using hyperspectral features from a ground based hyperspectral imaging system. Hyperspectral images of healthy and diseased plant canopies were taken at Rothamsted Research, UK by a Specim V10 spectrograph. Five wavebands of 20 nm width were utilized for accurate identification of each of the stress and healthy plant conditions. The technique that was developed used a hybrid classification scheme consisting of hierarchical self organizing classifiers. Three different architectures were considered: counter-propagation artificial neural networks, supervised Kohonen networks (SKNs) and XY-fusion. A total of 12 120 spectra were collected. From these 3 062 (25.3%) were used for testing. The results of biotic and abiotic stress identification appear to be promising, reaching more than 95% for all three architectures. The proposed approach aimed at sensor based detection of diseased and stressed plants so that can be treated site specifically contributing to a more effective and precise application of fertilizers and fungicides according to specific plant’s needs